Five takeaways from the CBO healthcare score


The long awaited analysis of the House GOP’s healthcare bill was released Wednesday, highlighting how the legislation could affect people who are low-income, older or have preexisting conditions. 

The score from the Congressional Budget Office (CBO) projects that the bill would cut the deficit by $119 billion but result in 23 million people uninsured by 2026.

Senate Republicans downplayed the score, vowing that the legislation passed by the House will be overhauled significantly. 

Here are five takeaways from the CBO’s analysis.

Some people with pre-existing conditions would likely lose coverage

A last-minute amendment to the legislation from Rep. Tom MacArthur (R-N.J.) helped win the support of the conservative House Freedom Caucus, but also ignited a charged debate about protections for people with pre-existing health conditions.

The amendment lets states opt out of certain core ObamaCare provisions. If states were approved for a waiver, insurers wouldn’t have to cover a list of 10 categories of services and could charge consumers more money based on their health status.

CBO found premiums would likely be lower in states that received the waivers, but not across the board.

Premiums would “vary significantly according to health status” and “less healthy people would face extremely high premiums,” the CBO found.

“Over time, it would become more difficult for less healthy people (including people with preexisting medical conditions) in those states to purchase insurance because their premiums would continue to increase rapidly,” according to the CBO report.

For those states that let insurers charge more based on a person’s health status, sick people would “ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all—despite the additional funding that would be available under H.R. 1628 to help reduce premiums,” CBO said.

States would use the waivers

Some Republican lawmakers have suggested states might not even apply for the waivers, making their potential effects meaningless.

“I still don’t think states are going to take that waiver,” House Energy and Commerce Chairman Greg Walden (R-Ore.) told reporters shortly after CBO released its analysis, “and they would have to clearly make their case that it would result in better coverage and more people covered.”

But the CBO projects that at least one-sixth of the population lives in states that would obtain both waivers. It did not specify which states, but they are most likely to be ones with Republican governors and state legislatures. Wisconsin Gov. Scott Walker has already expressed interest in the waivers.

The CBO estimates that in states that get the waivers, premiums would be lower for healthy and younger people but “extremely high” for sick people. Markets in these states could become “unstable” in 2020, the CBO warned.

About half the population lives in states that wouldn’t request waivers. In these states, average premiums would be about 4 percent lower in 2026 than under ObamaCare. 

About one-third of the population lives in states that may make “moderate” changes to their regulations, the CBO projects. In these states, average premiums could be roughly 20 percent lower in 2026 than under ObamaCare, but these plans could provide fewer benefits. 

Costs for maternity care, mental health treatment could go up

In states that took the waivers, insurers could charge much more for services like maternity care and mental health and substance abuse services, the CBO found.

ObamaCare requires insurers cover ten essential health benefits, like prescription drugs and maternity care. But in states that decide to get a waiver for that requirement, or narrow the scope of it, those services could become more expensive. 

“In particular, out-of-pocket spending on maternity care and mental health and substance abuse services could increase by thousands of dollars in a given year for the nongroup enrollees who would use those services,” CBO wrote. 

Senate Republicans are going their own way

Senate Republicans have long said they would be writing their own healthcare plan — and they emphasized that even more after the CBO score was released Wednesday. 

With CBO concluding that the House bill would hurt low-income, sicker and older Americans, centrist Republican senators quickly called for a new approach. 

Sen. Dean Heller (R-Nev.) said after the CBO’s release that he still opposes the bill “in its current form.” 

“This bill does not do enough to address Nevada’s Medicaid population or protect Nevadans with pre-existing conditions,” he said. 

“The AHCA is a first step, but not the solution; now the Senate is doing its own work to put forth its own ideas that could work for states like Nevada.”

House Republicans aren’t budging

The latest CBO score of the bill was the first to take into account changes that were made before the bill passed the House.

House Republicans brushed aside demands from Democrats that they wait for the CBO’s revised score before passing their bill, and on Wednesday said the analysis offered good news. 

“The American Health Care Act achieves our mission: lowering premiums and lowering the deficit,” Speaker Paul Ryan (R-Wis.) said.

Ryan, as well as other lawmakers, pointed to what they see as ObamaCare’s failures. 

“Under ObamaCare premiums have more than doubled and choices have dwindled to the point that many families have no options at all,” Ryan said in a statement.

Walden offered a similar sentiment: “It appears that it improves the number of people who will be covered and premiums continue to come down even more under this proposal,” he said.   

Lawmakers and administration officials were also quick to cast doubt on CBO’s accuracy.

Rep. Phil Roe (R-Tenn.), co-chair of the GOP Doctors Caucus, said CBO has been “wildly wrong” in the past. 

Tom Price — head of the Department of Health and Human Services — slammed the score as “wrong again” and dismissed the notion that premiums would rise for those who are sick.

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